Overdoing it on exercise

Most people who exercise find a way to work it into their lives. Robert Silvers of Marshfield, Mass., organizes his life around his exercise.

When Silvers recently told his wife that, sorry, he didn't have time to help fix her computer, she reminded him that he had just spent an hour and a half at the gym after running 10 miles. "But that's non-negotiable," he replied. "It's fixed into my schedule."

Exercise is something most people don't get enough of. But for some dedicated fitness enthusiasts, working out can turn addictive.

Though there's no formal diagnosis, therapists consider compulsive exercise a behavioral disorder, one that can cause lasting physical harm or interfere with daily life. Excessive exercising is difficult to identify and treat because it's easily rationalized as a healthy behavior. The symptoms, however, are the opposite of what an athlete strives for: increased fatigue, injury, irritability and problems with work and relationships.

Too much exercise may also be surprisingly hard on the heart. A recent study published in Mayo Clinic Proceedings suggests that while moderate exercise prevents many common diseases and improves health and longevity, extreme endurance exercise, such as marathons and Ironman distance triathlons, can cause structural changes and damage to the heart and large arteries.

"Physical exercise, though not a drug, possesses many traits of a powerful pharmacologic agent," said James O'Keefe, a cardiologist with Saint Luke's Health System in Kansas City, Mo., and lead author of the study. "A safe upper-dose limit potentially exists, beyond which the adverse effects of physical exercise, such as musculoskeletal trauma and cardiovascular stress, may outweigh its benefits."

Silvers, 44, who stabilizes his Type 1 diabetes with exercise, says he's not an addict. Instead, he's goal-driven and works hard, qualities that serve him well in his professional life.

To get his body fat down to 4 percent — his latest goal — Silvers recently logged 70 miles of running over a week, lifting weights on four of those days for at least an hour. He wears an activity tracker called a FitBit, weighs every gram of food and keeps a log to make sure he burns more calories than he eats.

Silvers' wife, Chris, sees his compulsion a little differently. "It's great to have the ambition, drive and perseverance to stick with a regimen, but if it takes you three hours a day and you don't have time to hang out with your family, then you have to look at your priorities and make adjustments," she said. "He exercises an excessive amount for the time we have as a family."

Experts say that if exercise is disrupting normal areas of your life — such as your relationship or work — and you experience withdrawal symptoms when you stop working out, you could be overdoing it.

"There's a rigidity to exercise addiction," said Adam Naylor, the lead consultant at Tella Sports Psychology Coaching and a clinical assistant professor at Boston University. "The aura around the person has edges if they are not able to go for a run today or are not willing to bump it to later in the day. It's linked closely to disordered behavior; one continues to do it even though there is a physical detriment."

Addicts may bike or run through injuries, miss important events to fit in a workout or find unique ways around a doctor's order to stop. Compulsive exercise is also closely linked with disordered eating habits. One recent study showed approximately 39 percent of people with anorexia and 23 percent of people with bulimia have an exercise addiction.

Those with an extreme fear of weight gain may compulsively exercise and eat according to their workout levels, a condition sometimes called "anorexia athletica," said Indianapolis-based sports dietitian Lindsay Langford. Or it can be used as a form of purging, playing the same role as bulimia.

One of Langford's clients was wrestling with body image issues. When an injury made it impossible to bike or run on a treadmill, the athlete began running in place for up to an hour. "This was perceived to have less impact on the joints and would still allow for healing," said Langford, a nutrition coach at St. Vincent Sports Performance. "It was actually acceptable for the healing of the injury, but definitely an odd and obsessive behavior."

Still, identifying a problem can be tricky because "the addiction comes in the form of a healthy habit," said Holly Parker, a personal trainer, psychologist and psychotherapist at Harvard University. Or, they may join a culture that thrives on overdoing it. Ironman triathlons, for example, involve completing a 2.4-mile swim, a 112-mile bike ride, followed by a 26.2-mile marathon. Athletes training for these events often don't think twice about working out twice a day or topping off a 100-mile bike ride with a 4-mile run.

While there's nothing inherently dangerous about training for an Ironman race if you're healthy, "the marker is whether there is enough rest and recovery in between," said Naylor. "If you're resting smart it shows you truly get the nuances of the sport." If you've got to keep going 'or else,' it's a warning sign," said Naylor.

Silvers has no plans to let up. He's determined to reduce the 4.5 millimeters of fat on his abdomen — at one point it was over 10 millimeters — the fat most people call "stubborn."

"Let's see how stubborn it really is," he said. "I am confident it cannot survive my current routine."

Do you have a problem?

Exercise is such a healthy and important part of a vibrant lifestyle that it's often difficult to see how and when a line is crossed into exercise addiction, said Holly Parker, a Harvard-based psychologist who specializes on the impact of exercise on mental health and exercise-based treatments.

But if the following five descriptions ring true, this "strongly suggests that the relationship with exercise is destructive and help to break this pattern may be needed," said Parker. Therapists can help. Also consider seeing a health and fitness professional, such as a certified personal trainer, to learn more about healthy levels of exercise, Parker suggested. "Social support is also a very important for coping and making healthy changes," she said.

1. Exercise starts taking away from other parts of your life, such as relationships, work, etc. and/or you spend an excessive amount of time thinking about exercise and planning around it, such that it markedly interferes with your ability to focus on other parts of life.

2. You feel extremely anxious and upset whenever your workout is interrupted or you can't exercise.

3. You are spending several hours (3 plus) at the gym on an almost daily basis and you're not a professional athlete.

4. You continue to exercise even when you're very sick or injured.

5. The people you care about are expressing concerns about how much you exercise.

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